We describe the case of a 33-year-old drug addict who developed Pisa syndro
me (pleurothotonus) following an intoxication with tramadol, alprazolam, di
azepam, bromazepam, alcohol and dothiepin. Pisa syndrome abated as the pati
ent recovered from his intoxication. We discuss the possible causes of Pisa
syndrome and suggest that high doses of the tricyclic antidepressant dothi
epin might be the most appropriate explanation for the appearance of Pisa s
yndrome in this patient.